Employees at Dartmouth-Hitchcock
Medical Center (DHMC), an academic facility in Lebanon, NH, that includes a
400-bed tertiary hospital, research and clinical space, work for an organization
that places prime importance on sound environmental stewardship — and they become
aware of that fact their first day on the job.

That’s because environmental
education is an integral part of the orientation process, and every individual
who joins the facility must participate in that process. "I get 45 minutes with
them, whether they are a janitor or an MD," says John Leigh, recycling
& waste minimization coordinator at DHMC. "It’s required, and they all get
it — regardless of their background."

No doubt it is this determined
attitude, along with an extensive program, that made DHMC one of the four hospitals
to receive the annual Environmental Leadership Award from the Hospitals for
a Healthy Environment (H2E) program, a joint national effort of the American
Hospital Association, the U.S. Environmental Protection Agency, Health Care
Without Harm, and the American Nurses Association.

"The health of our patients,
staff, and community are directly impacted by the choices we make about what
products and practices we use," says Leigh.

"As part of the first-day
orientation, I bring up the notion that the stuff that we use absolutely impacts
the long-term health of the community — so is it not part and parcel of our
core mission to be good environmental stewards as we deliver quality health
care?"

DHMC started to look at
recycling and environmental stewardship in general in 1991, when it moved to
its current facility, Leigh says. "This position, however, did not come around
until 1995."

The commitment of top leadership
is clear, he adds. "They have been refilling this position and moved it from
part-time to full-time," he notes.

It’s virtually impossible
for a health care facility to not be affected by the pollution of the world
outside, Leigh explains. "At any stage of a product’s life cycle, unfortunately,
a certain amount of pollution goes into the environment and can be translated
into health care," he says. "A certain amount of pollution occurs quite legally,
yet nitrous oxide and sulfur dioxide, for example, are significant pollutants
that come out of power plants and are known to contribute to respiratory illness."

With the amount of stuff
we purchase, says Leigh, "if we are wasteful in any way, certain products may
have a greater impact. Becoming knowledgeable about the preferability of competing
products becomes the kind of thing a health care organization our size should
get into. We also have to keep up with which products are determined by [environmental]
groups to be preferable."

On orientation day, Leigh
is given 45 minutes with the employee. "We bring all of them down to the waste
management center and let them see how it is we handle the 6+ tons of discards
per day; we show them where they throw their trash, recyclables, and infectious
waste, and how it impacts the individuals who are co-workers of theirs. They
get to meet the staff who run the center and physically observe their activities.
So, waste is no longer some black hole that is forgotten once it hits the trash
bin."

In addition, Leigh covers
what employees need to do to properly handle infectious waste, and what gets
recycled at DHMC. "We want to make sure that what can be recycled gets
recycled," he explains, "And we teach them how to reduce the amount of waste
they generate on a personal basis." For example, he says, they are taught different
ways to reduce the amount of paper they use — such as using both sides of a
sheet of paper when copying.

"I also give them guidelines
on how to recycle the many things they will probably have to recycle," he says.
"I give them a characterization of our waste stream and show them a graph of
how we’ve be successful in land-filling less as we’ve increased our recycling
rate over the years."

Leigh also impresses on
the employees the message that everyone is involved in DHMC’s environmental
programs. "With 4,600 people working here, we depend on them to carry some of
the knowledge they’ve picked up to the veterans with whom they work in their
department," Leigh observes. "I hope the newbies’ can question what they see
as they observe certain practices; and where those that are in place are not
what I’ve told them, it might be good food for a conversation either with the
vets or with me. If it’s something involving the system, then I have to correct
it."

The orientation session
is just one part of an ongoing process at DHMC. Leigh provides some inservice
training by getting on the agenda for sectional or divisional staff meetings.

"For example, the cath
lab staff get together once a month early in the morning before they start the
day. I’ll get 10-15 minutes on the agenda to make sure to try to correct things
I see happening, such as people not doing a great job of recycling, or the improper
placement of an infectious waste container," he explains.

Leigh also interfaces with
quality control, sitting together on a committee headed by the purchasing department
that evaluates any new product that comes into the hospital. "Since I’ve been
sitting there, the members of the value and analysis committee have started
thinking in terms of whether a given product is disposable or reusable," he
notes.

In addition, Leigh gets
involved in environment of care or safety team tours. "These involve areas like
safety, engineering, or housekeeping on a weekly basis; every area of the hospital
is covered in the course of a year," he continues. "I join in on these; it allows
me to monitor things like waste containers, to educate the staff on an informal
basis, and to basically ask them how it’s going."